Stucker F, et al. - This study provides information on various dimensions of community-acquired acute kidney injury (CA-AKI), including its clinical characteristics, the effectiveness of initial management, its prognosis and the effect of medication on its occurrence in patients with previous chronic kidney injury (CKI). As per the findings, male patients and those treated with diuretics more frequently suffered from CA-AKI, which was identified as an independent risk factor for long-term mortality. Furthermore, it was obvious in this work that its initial adequate management failed to improve outcomes.

Methods

• A prospective observational study was performed within the Emergency Department (ED) of a University Hospital, screening for any patient >16 years admitted with an eGFR <60 ml/mn/1.73 m² and a rise in serum creatinine as compared to previous values.
• A panel of nephrologists reviewed patients’ medical files in the subsequent days and at one and three-years follow-up.

Results

• A total of 8464 admissions were reported in the ED from May 1 to June 21 2013, of which 653 had an eGFR <60 ml/mn/1.73 m².
• Of these, previous CKI, CA-AKI, and CA-ACKI (community-acquired acute on chronic kidney injury) were noted in 352, 341, and 104, respectively.
• Findings demonstrated that occurrence of superimposed CA-AKI in CKI patients was associated with male gender and with use of diuretics, but not with use of ARBs or ACEIs.
• In addition, researchers noted that 45% of the cases received adequate management of CA-AKI defined as identification, diagnostic procedures and therapeutic intervention within 24 h and it was not associated with improved outcomes.
• They also found that 3-year mortality was 21 and 48% in CKI and CA-ACKI patients respectively, and 40% in patients with only CA-AKI (p < 0.001).
• A significant association of mortality with age, hypertension, ischemic heart disease and CA-AKI was highlighted in the findings.
• Additionally, a link was noted between progression of renal insufficiency and male gender and age, respectively.